# CHESAPEAKE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700100583
- **Authorized official:** MRS. CAMILLE PERGOLA (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (804) 435-8570

## Contact information

- **Practice address:** 18682 NORTHUMBERLAND HWY, REEDVILLE, VA 22539-3411
- **Practice address phone:** (804) 453-4537
- **Practice address fax:** (804) 453-4317
- **Mailing address:** PO BOX 1328, KILMARNOCK, VA 22482-1328
- **Mailing address phone:** (804) 435-8664
- **Mailing address fax:** (804) 435-8037

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101028388 | VA | Yes |

## Other

- **Enumeration date:** 03/23/2010
- **Last updated:** 08/02/2010